The effect of antifibrotic agents on acute respiratory failure in COVID-19 patients: a retrospective cohort study from TriNetX US collaborative networks.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on global health and economies, resulting in millions of infections and deaths. This retrospective cohort study aimed to investigate the effect of antifibrotic agents (nintedanib and pirfenidone) on 1-year mortality in COVID-19 patients with acute respiratory failure. METHODS: Data from 61 healthcare organizations in the TriNetX database were analyzed. Adult patients with COVID-19 and acute respiratory failure were included. Patients with a pre-existing diagnosis of idiopathic pulmonary fibrosis before their COVID-19 diagnosis were excluded. The study population was divided into an antifibrotic group and a control group. Propensity score matching was used to compare outcomes, and hazard ratios (HR) for 1-year mortality were calculated. RESULTS: The antifibrotic group exhibited a significantly lower 1-year mortality rate compared to the control group. The survival probability at the end of the study was 84.42% in the antifibrotic group and 69.87% in the control group. The Log-Rank test yielded a p-value of less than 0.001. The hazard ratio was 0.434 (95% CI: 0.264-0.712), indicating a significant reduction in 1-year mortality in the antifibrotic group. Subgroup analysis demonstrated significantly improved 1-year survival in patients receiving nintedanib treatment and during periods when the Wuhan strain was predominant. DISCUSSION: This study is the first to demonstrate a survival benefit of antifibrotic agents in COVID-19 patients with acute respiratory failure. Further research and clinical trials are needed to confirm the efficacy of these antifibrotic agents in the context of COVID-19 and acute respiratory failure.

Application of Fluorine-18-Deoxyglucose Positron Emission Tomography and Gallium Scan for Assessment in a Patient With Adult-Onset Still's Disease.

A 53-year-old female patient suffered from pain in almost her entire body, particularly the joints. Chest computed tomography revealed multiple lymphadenopathies over cervical, mediastinal, and axillary areas. A fluorine-18-deoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) revealed increased FDG uptake in many lymph nodes and the spleen. Lymphoma was suspected. However, the result of a biopsy showed no malignancy, and the gallium-67 citrate scan showed no gallium-avid tumor throughout the whole body. Adult-onset Still's disease was diagnosed and the patient responded well to steroid therapy. The follow-up PET/CT six months later showed complete remission of the FDG-avid lesions seen in the previous PET/CT. Our study suggests that FDG PET/CT combined with gallium-67 scan may be helpful in diagnosing patients with adult-onset Still's disease. In addition, the use of FDG PET/CT alone may be useful for the evaluation of disease distribution, disease activity, and therapeutic response.